The UW Medicine Functional and Restorative Neurosurgery Program employs Deep Brain Stimulation (DBS), lesion surgery and other innovative technologies to care for patients with neurological conditions such as Parkinson’s disease, essential tremor, dystonia (abnormal movement) and other complex movement disorders. The program is part of the UW Medicine Neurosciences Institute, a comprehensive, multi-disciplinary consortium that diagnoses and treats complex conditions of the brain, spine, and central nervous system.
Within the Functional and Restorative Neurosurgery Program, there is an emphasis on the emerging treatment of DBS. Neurological conditions such as Parkinson’s and essential tremor are often first treated with medications by a movement disorders neurologist. At UW Medicine, the movement disorder neurologist works hand in hand with a neurological surgeon to manage these conditions and assess when quality of life is no longer acceptable on medical therapy alone. It as at this point that DBS surgery is considered. DBS does not cure these disorders or change the way the disease is progressing, but it can help alleviate some of the symptoms related to the movement disorders.
Our team takes a multidisciplinary approach to preoperative evaluation for diagnosis and treatment planning, as well as postoperative management of therapies. We conduct world-class research that is made immediately available to benefit our patients. Our team is one of the longest standing and most comprehensive in the Northwest, and cares for patients from around the country and the world.
Our physicians combine the latest technology with individualized, compassionate care to empower patients to make the most appropriate choice for their neurological health. Our research programs bring leading-edge advances in the neurosciences from the laboratory to the clinic and operating room, improving the quality of life for all patients.
The Functional and Restorative Neurosurgery Program offers innovative treatments to help patients with movement disorders improve their quality of life by addressing some of their symptoms.
- Medical and surgical management of movement disorders
- Procedure planning using high-resolution MR imaging
- Preoperative evaluation and postoperative management
- Asleep implantation of DBS with intraoperative imaging
- Awake implantation of DBS with intraoperative imaging
- Clinical trials in patient-responsive Deep Brain Stimulation
As part of the UW Medicine health system, the program also enables patients to access the latest in research discoveries and clinical innovations. We offer consultations and treatment at the Neurological Surgery Clinic at the UW Medical Center.
Deep Brain Stimulation
The symptoms of diseases such as Parkinson’s disease, essential tremor and dystonia are caused by abnormal communication between nerve cells. Deep brain stimulation (DBS) delivers an electrical current to small areas of brain tissue near the brainstem. This electrical current changes, or modulates, the communication between nerve cells in the brain. By silencing this abnormal communication, DBS can effectively improve symptoms of movement disorders, such as slowness of movement, stiffness or tremor.
The electrical stimulation to the brain is delivered through a fine wire that is passed through brain tissue to reach a target deep in the brain. The wire extends to an implanted neurostimulator, or brain pacemaker, that is usually placed in the chest. The entire system is placed beneath the skin. The neurostimulator can be programmed to many different settings using a device that communicates with the neurostimulator through the skin.
The UW Functional and Restorative Neurosurgery Program offers a comprehensive set of the most current imaging technologies and Deep Brain Stimulation procedure techniques. Here is just a sampling of some of the technology that our team relies upon to maximize patient comfort and ensure optimal outcomes.
- High-field MRI with diffusion tensor imaging, and customized software for use in tractography (a 3-D modeling technique) and operative planning)
- Intraoperative CT
- Microelectrode recording
- Patient-responsive DBS (in development)
After you are referred to the Functional and Restorative Neurosurgery Program, our multidisciplinary team will perform a comprehensive evaluation before you undergo any surgical procedures.
Your first visit will most likely be with a movement disorders neurologist who will discuss the progression of your disease, your symptoms and your current medications. You’ll then speak with the neurosurgeon who will perform the surgical procedure that makes DBS possible. During this consultation, you’ll have the opportunity to discuss your expectations for DBS, while the neurosurgeon will assess whether your symptoms are likely to be improved by the treatment.
After that visit, the team will likely schedule further evaluation with a neuropsychologist and a physical therapist who have experience helping patients with movement disorders. These consultations help our team better understand your symptoms, so that we can maximize the benefits you may receive from DBS.
DBS surgery is usually divided into two stages. In stage one, the DBS leads (brain wires) are placed into the brain. In stage two, the neurostimulator device (brain pacemaker) is implanted and connected to the DBS leads with an extension wire.
During the first procedure, the neurosurgeon will implant the DBS leads. Most hospitals use a trial-and-error system to implant the wires during a surgical procedure while the patient is awake. At UW Medicine, we use a combination of high-resolution MR imaging and an intraoperative CT scan to pinpoint the precise place where we need to implant the electrodes in the brain.
This eliminates the trial and error — and extra operative time — and allows our neurosurgeons to implant the wires while the patient is asleep. This results in a more comfortable, faster procedure with less surgical risk. You will stay overnight in the ICU and most likely be ready to return home the following day.
The second surgery is an outpatient procedure that involves hooking the wires up to the neurostimulator, or brain pacemaker, that is usually placed in the chest. This outpatient procedure is performed under general anesthesia approximately two to three weeks after the first surgery.
In the procedure, a stimulator device is typically implanted on each side of the upper chest so each of the two devices stimulates a side of the brain. It is also possible to have a larger stimulator implanted only on one side that stimulates both sides of the brain. Currently, the stimulators contain a non-rechargeable battery that must be replaced every four to five years through another surgical procedure.
Two to three weeks after the second surgery, you’ll return to the clinic. We’ll turn on the stimulator and begin programming it to most effectively alleviate your symptoms. This process may take several months because your care team will be fine-tuning the programming and adjusting your medication at the same time.
Six months after the implantation procedure, you’ll have a follow-up visit with your care team to check on the effectiveness of the treatment, monitor any side effects, and assess any improvements in your quality of life.
After DBS surgery, patients are often able to reduce their medications in consultation with their neurologist. Patients with Parkinson’s disease should never abruptly stop taking their medications.
This procedure is considered to be a safe, elective surgery. However, as with any surgical procedure, there are risks associated with the implantation of the DBS leads and stimulator device. Major risks include bleeding in the brain, stroke, infection or incorrect placement of the DBS electrode. Other risks and side effects are associated with sedation and stimulation of the brain. Certain special precautions need to be taken after surgery.
For more information about risks, possible side effects and precautions, speak with a neurosurgeon who practices this surgery or a movement disorders neurologist who is familiar with the surgery.